## TRANSMITTA Lof OMAH A LEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R SAID# : r5 \<=\6 ^ Date : /i//^/ao«^ ^ Address : 8^5 " S .Qf i 3 f Remediation Contractor : f^ur/p-n- T l^/Lii-f^y^r^r? i g g , ifHC y Year ; f^)QD9 i SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S e f

Vide o of propert y (DVD ) aExecutiv e Sunmiar y s f

E PA-pTOvide dpropert y sketch H SignedAcces s Agreemen t fo r

subject propert y D SignedAcces s Agreement(s ) fo r

adjacen t propert y aRestoratio n Agreemen t D Settlemen t documents (i.e. , fo r

damag e or t o replac e plants , etc. ) dConfirmation data H Photograph s o

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As-built sketch 0 Satisfector y restoratio n signedby Propert y Owne r aPropert y close-out check lis t signedby EP A aDescriptio n o f area s no t meeting RO D cleanu p criteri a aUtilit y clearance s [ ^ Propert y informationfromDougla s Count y Assessor' s Ofi&c e D D D 

## Signatur e " ^ . . Dar e 4031292 9



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### PROPERT Y SUMMAR Y Date : 11/19/200 8 Omah aLea dSit e Remedia l Actio n Contrac t #EP-R7-07-06/000 4 Mont hof : Oct/Nov . Propert y Address : 82 5 S 3 6 S T A . EXECUTIV ESUMMAR Y A. 1Issue s Encountered : NON E A. 2Issue s Resolved : NON E A 3Uniqu e Findings : NON E A. 4Othe r Relevan t Information : ARE A NO T EXCAVATED , B 2 BUSHES , S'XIS ' @ 26 5 PPM ; CONTAMINATIO NLEF T BEHIND , B 2 BUSHES , rX3 ' @ 81 0 PPM . CONFIRMATIO NSAMPLIN GDATA/RESULTS : B 2 = 18 9 PP M @ 10" , F l = 2 6 PP M @ 6" , D Z= 38 1 PP M @ 12" , E A = 25 1 PP M @ SCRAPE . ATTACHMENT S 1 ) Property sketc hprovide db y EPA pursuan t t o contrac t specification s 2 ) Signe dAcces s Agreemen t includin g acces s agreement s require dfor crossin g othe r propertie s 3 ) Pre-Excavatio ndigital vide o clip/photograph s 4 ) Post-Excavatio n digital vide o clip/photograph s 5 ) Documentatio n- Complete dClose-ou t Checklis t 6 ) As-Buil t sketc h­ i ) Shal l includ e final leadlevel s v ) Legen d ii ) Contaminatio n lef t behin darea s vi ) Contracto r identificatio n iii ) Property addres s vii ) Dat e iv ) BVI D numbe r 7 ) Othe r item s t o b e include din th e individual property file, i f available , o r obtaine dinclude : i ) Pre-excavatio n agreemen t detail s (i f an y ar e mad e v^'it hth e property owner ) ii ) Property Statu s For msigne db y property owne r iii ) Excavatio n digita l vide o inMPEG , WM V (Window s Medi aVideo ) o r SWF(Flas hPlayer ) format and/o r photograph s iv ) Signe dfor mverifyin g satisfactory restoratio n v ) Descriptio no f area s no t meetin g Interi mRO D cleanu p criteria .

TECHNOLOGIES , INC .Fin d Rec»rd I Clea n U p Quer y Lea d Remainin g Quer yI Propert yDamag e Quer y 

### Backfill :

Sampl e Area : 2196 9 Owner : ­ 82 5 S 3 6 S T

n Owne rOccupie d Owne rName : [SHOCKLE YCANDIC E D Owne rAddressl : | | Owne rAddress2 : |825S36S T City : )OMAH A Owne rPhone : 1(420)296-181 0 State : Zi p Code : 

### JN E J6810 5 Alternat e Phone : |(402 ) 598-115 3 |

| Resident : Residen t Name : SHOCKLEYCANDIC E D PropertyAddress : (82 5 S 3 6 S T 

### Zi

p Code : [6810 5 Residen t Phon e Contract : Contractor : Group : Assessment : Qualifyin g Grou p [80 0 Assessmen t XR F Date : 

# I Assessmen t Ma xXR F Value : 

## I 8S 3• ITCHNOLOGIES,IN C Propert y # : 2.)'?fe'J Date/Time : Quad s Excavated : F» , g % D^
- 

# SEB V EP A Propert y Clos e Ou t Propert y Address : Sx 5 S 3 4 ^ Owner' s Name : Contracto r Grou p Pruden t Technologie s Excavatio nGenera l 

### Ye s N o 1 . If necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

### y 2 . If necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

# y Gradin g So dan dVegetatio n 

### Ye s N o 1 .Doe s th e gradin g aroun dth e perimete r o f th e hous e i nexcavate darea s generall y slop e away fromth e house ? 

### ^ 2 .

Ha s so dbee nlai dinal l area s that wer e excavated ? 

### y ^ 3 .Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte da t a3 0 day tim e period ) cy ^ 4 .Ar e sodde darea s generall y firman devenl y graded ? i ^ 5 .Ar e th e joint s betwee n th e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat a3 0 day tim e period ) 

## Z 6 .Wa s th e property grade dsuc hthat wate r wil l no t poo l o nth e property ? i ^ 7 .Wa s damag e t o landscapin g o r plan t material s avoided ? t / Gates , Fence s an dRetainin g Wail s 

### Ye s N o 1 .D o gate s ope nan dclos e freely? (I f applicable ) 2 .Wer e al l gate s o r fence s take ndow ndurin g restorationactivitie s reinstalled ? (I f applicable ) i ^ 3 .

Wa s damag e t o gate s o r fence s avoided ? (I f applicable ) L y ^ 4 .

Wa s damag e t o retainin g wall s avoided ? (I f applicable ) 

### y Foundation , Sidin g an dGutter s 

### Ye s N o 1 .Wa s damag e t o th e sidin g o r tri mavoided ? 

### ^ 2 .Wa s damag e t o th e foundatio navoided ? Ly ^ 3 .Wa s damag e t o windows avoided ? 1 ^ 

### ' 4 . Wa s damag e t o windows o r doo r screen s avoided ? iy ^ 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? 

### - Ly ^ Sidewall u an dDriveway s (Concrete ) 

### Ye s N o 1 . Wa s damag e t o driveway surface s avoided ? 

### ^ 2 . Wa s damag e t o walkway surface s avoided ? 

### L ^

### Owner s comments :

Inspectio nnotes :

Remova l an drestoratio n activate s complet e includin g th e 30-day so dwarranty : EP A Representativ e /?r. ^ ^ . Date : /^ygy/^:.'j >

# &ERI V Propert yCompletio n Agreemen t Thi s agreemen t documents th e completio no f remova l activitie s performe do n th e belo w liste dproperty . Th e property owner' s signatur e indicate s tha t th e property owne r i s satisfie dwithth e restoratio n o f th e subjec t property , an dtha t n o item s ar e inquestion , now , o r at an y tim e in th e future , excludin g an y remaining warranty (3 0 day s total ) excep t thos e item s liste dbelow , i f any . Property ID : Property Address : Z > Z S 

### Owner : CLay^..^U ^ Phone : ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item : Require d correction s t o complet e th e property :

\F \ I agre e restoratio n i s completed , excep t a s note d above . I I d o no t agre e restoratio n i s complete d 

# h,Krlji.i_/yiM M 

# %J ^ ^ Owffer' s Signatur e Date V IPruden t Technologies , Inc . (Prudent ) i s unde r contrac t wit hth e U . S . Environmenta l Protectio n Agenc y (EPA ) t o clean up lead
contaminate dsoil s a t anumbe r o f

propertie s locate di n Omaha , Nebraska , includin g th e property locate da t

. Th e EPA request s you r permissio n t o allo w Pruden t t o perfor masoi l cleanu p a t this property t o remove lead-contaminate dsoil . B y signin g this form , tli e property owne r grant s permissio n t o Pruden t t o perfor m activitie s relate dt o th e cleanu p includin g soi l sampling , removal o f lead-contaminate dsoil , an drestoratio n ofth e reference dproperty . If

yo u hav e any question s abou t th e soi l cleanu p planne dfo r you r property , pleas e contac t Prudent' s Administrativ e Cler k for th e Omah aLea dSite cleanup . Ms . Madhurim aDur u -a t (402 ) 733-1188 , 733-1455 . General question s abou t th e Omah aLea dSit e cleanu p ca nb e directe dt o th e EPA Publi c Informatio n Center s a t (402 ) 731-304 5 (Sout hOmah aoffice ) o r (402 ) 991-958 3 (North Omah aoffice) . Property Acces s Grante dBy : _ KJ/^ ' I f (f'leas e PrintNarae V 

# hdjuAmFM ^ Property Owne r Signadire : _ (Date ) FOft i PROPERT YINFORMATIO N (T o be complete d b yresiden t and/o rpropert yowne r—please print ) RESIDEN TNAME : Owne r Rente r RESIDEN TADDRESS : 

# ^2 S 

# 2 

# 3 ^ ^ .^ 4 r:)w.^.JU ^ M ^ Gsio c I F RENTAL , PROPERT YOWNED BY : 

# Ccxti.(\:c esu^c^-^c l ^ OWNER' S MAILIN G ADDRESS ; 

## f> e Q ai o y 

# v ^ - O F OWNER' S TELEPHON E NUMBER - HOME : J _ WORK :
AG E O F HOME? : 

## fcr p YEARS . HO W LON G HAV E YO U LIVE D HERE ? YEARS . HA S TH E EXTERIO R BEE N PAINTE D O R COVERE D WIT H SIDIN G SINC E 1978 ? YE S N O NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDE R NUMBE R O F CHILDRE NUNDE R 7 YEAR S OL D WH O PLA Y I NTH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR Y GATES , ETC. )

AUTHORIT Y FO RENVIRONMENTA LRESPONS EACTIONS : Th e activitie s t o b e implemente db y EPA unde r this agreemen t are pursuan t t o Sectio n 10 4 o f CERCLA , 4 2 U.S.C . 9604 . EPA' s right o f

acces s t o th e property i s provide dfor i

n Sectio n 104(e ) o f CERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry for "determinin g th e nee dfor response , o r choosin g o r takin g any respons e actio n unde r this title , o r otherwis e enforcin g th e provision s ofth e title. " 808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (SIB ) 363-370 7 =3x : (402)504-100 5 Fax : (210 ) 579-657 7

### A S - BUIL T DRAWIN G OMAH A LEA D SUPERFUN D SIT E OLS * 2196 9 Dat e Excavated : 9/1S/200 8 Dat e USEP A Signed-Off : 

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## fl^3 1 1 2

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## n D D D D Sample s Collecte d Finn : foA!>&/.Jt > Date : ji/PO/Cg , Time : . ? : L" ^ f>n ^ Sample s Analyze d XR F Unit : CaSH D Book : WaZ3GPXA-g196 9 -e s pp m 

### D D Date : ~\ ­ IC>-OS > RPZaePXA-g19C 9 PZ - — pp m 

## n D Time : At l Staff : M<U / Numbe ro f Sample s = i S 

# o . Legend : F l = Fro m Left , F 2 = Fron t RigW . B I = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla y A N quadrwits «r « a s vw«« d frrv n th « strqet , facin g propert y

CONTRAC T# : E P - R7-07-0 6 / 000 4 PRUDEN TTECHNOLOGIES , INC .

# >RUDEN ' rECHNOLOGIES , MC . 

# Propert y Statu s For m Address : g'2' S S?)G^<1V
- Date : ^ 1 o (, | b 9 ^ Phone : q ^ ^ _ q^ ^ ^ ^^^^ ^ BVID : ; z I q^ ^ Plant s & Permanen t Landscapin g Item # O n Ma p Descriptio n an dLocatio n 

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- N o — Item # Descriptio n & Locatio n O n Ma p

Property Owne r Pruden t Employe e Signature : Signature : / / 308 0 WardParkway , Suit e 40 s 250 5 N . 24'- ' Strsst , stit e 30 6 4,24 2 Medical Dnv©-&«itg425 0 Kansa s City , M O 6411 4 Omaha . Nabrask a9811 0 Sa nAnionic , TX7te2 9 Phone:(B16)3B3-370. ? Phons : (402)504-100. 4 Phons ; (210).822-9S8 8

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### Sit e Sketc h Q Goo d • Poo r Samplin g Address : 82 5 S 3 6 ST • Not pain t Sampl e Numbe r Lead Sampl e Sample s Collecte d 

# I LA B Concentratio n Collecte d Firm : foA£>5/J7 > RYASCPXA-2196 9 F l QS 3 pp m 

## D Date : h/?D/oe > RYBSCPXA-2196 9 F 2 1 1 Z pp m 

## D Time : ^'.L<=;f>M RYCSCPXA-2196 9 B I _3_jL6_PP m 

## D Sample s Analyze d RYDSCPXA-2196 9 B 2 H q G pp m 

## D RD2SCPXA-2196 9 D Z 3 I I " 7 pp m 

## D XR F Unit : CaS^i O Book : 2o6 > RQZ9GPXA-2190Q 9 * " pp m 

## D D Date : -]-/& - Ofi > r^PZOCPXA-21900 PZ - ~ pp m 

## D Time : ^ 

# n Staff : M<U / Numbe ro f Sample s = j 5 " j ^ | Legend : F l = Fron t Lett , F2 = Fron t Right , B I = Bad e Lett , B2 = Bac k Righ t DZ = Dri p Zone , G Z = Garden , PZ = Play AH quadrant s ar e a s viewe d fro m th e street , lactn g propert y

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### YOU RTICKE T NUMBE RI S 2126635 . Origina l Cal l Date ; 9/09/0 8 Time : 9:2 5 am Op : R7\MITA1896 7 Wor k t o Begi n Date : 9/11/O S Time : 10:0 0 am State : N E County : DOUGLA S Place : Ol^lAH A Address : 82 5 Street : S 36T H S T Twp : 15 NRng : 13 E Sect-Qtr : 20-SE,21-S W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : lea d remediatio n projec t Locatio n o f Work : LOCAT E ENTRI E PROPERT Y LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : {402)733-188 3 : UNSUR E CORNER S Compan y: PRUDEN T TECHNOLOGIE S Contac t Name : RAMIT A Phone : (402)733-145 5 Alt . Contact : Phone : (402)733-118 8 Wor k Bein g Don e For : ep a Dept h o f Excavation : 6 f t Corne r Lot : NFront : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g : NExplosives : N BSHPCLK S CXCAT V LEVEL 3 MCLEODN E MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Contac t Phon e Numbe r Utilit y Typ e BSHPCLK S NEBRASK A HEALT H SYSTE M N A 

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### Day : 402934046 9 Ah : 402934046 9 Emerg : 402932975 7
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### Day : 877366834 4 Alt : Emerg : 877366834 4 Day : 800289190 1 N O NEE D T O CALLOU T MCLEODN EMCLEODUS A EMERGENC Y 

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### Pag e 2 o f 2

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## Ah : Emer g Day : Alt : Emer g Day : Alt : Emer g Day : 

## Ah : Emer g 800289190 1 402504782 3 402504794 6 402444719 7 402444516 1 402444516 0 406728934 3 888728934 3 406728934 3 406728934 3 888728934 3

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